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JSM Dentistry Cite this article: Kaya F, Ertugrul AS (2016) A Management of Lip Adhesion with Vestibuloplasty: Case Report. JSM Dent 4(1): 1057. Central *Corresponding author Abdullah Seckin Ertugrul, Department of Periodontology, Izmir KatipCelebi University, Izmir, Turkey, Tel: 90-232-352-4040; Email: Submitted: 11 April 2016 Accepted: 25 April 2016 Published: 26 April 2016 ISSN: 2333-7133 Copyright © 2016 Ertugrul et al. OPEN ACCESS Keywords • Lip adhesion • Vestibuloplasty • Keratinized tissue Case Report A Management of Lip Adhesion with Vestibuloplasty: Case Report Fadime Kaya and Abdullah Seckin Ertugrul* Department of Periodontology, Izmir Katip Celebi University, Turkey Abstract Lip and cheek adhesion due to trauma, burns or tumors causes inadequate vestibular depth. Shallow vestibule appears clinically as mucogingival stress that may be a reason of esthetic and functional problems, such as recession. In this case, 70 years old female patient represent with complaint of restricted upper lip movement. Clinic examination and patient history revealed that, patient has scar tissue through the mucogingival line due to chemical burn. There was no keratinized tissue and 4mm recession around left canine teeth in the maxilla. Treatment plan was increasing keratinized tissue and eliminating lip adhesion. Although, vestibuloplasty plus free gingival graft was chosen to correct soft tissue defect, patient refused to have any donor area on her palate. Only vestibuloplasty was performed. After 4 weeks healing, mucogingival stress eliminated and 6mm keratinized tissue was seen on the area. 2 months follow-up showed 2 mm relapse on mucogingival line. But, patient satisfied with result. INTRODUCTION Trauma, burns, tumors and cysts of the oral cavity may lead to lip and cheek adhesion. Due to lip adhesion to the alveolar mucosa, loss of vestibular depth may see [1].The consequence of such resultant complete or partial vestibular loss includes; continuous saliva drooling, impaired mastication, and compromised speech [2]. For years, the choice of treatment varied from aggressive surgical excision to reform a new vestibule. For preventing soft tissue relapse, graft materials were used to cover opposing connective tissue surface [3]. The main three techniques have been described in the literature. These are submucosal vestibuloplasty, secondary epithelialization vestibulolasty (Kazanijan technique) and soft tissue grafting vestibuloplasty [4]. Over the past decades, using free gingival grafts (FGG) with vestibuloplasty has become more popular. Main advantage of FGG is that provides abundant tissue to entirely resurface the opposing connective tissue walls and adequate keratinized tissue to stabilize lips muscle. Despite the advantages of FGG, there are many disadvantages such as, donor site morbidity, color and texture difference and difficulty in achieving immobilize graft position during healing course [5]. In this case the treatment plan was to perform FGG and vestibuloplasty. But patient didn’t accept to have any donor site in her mouth. This case report is to describe only vestibuloplasty to maintain adequate keratinized tissue around the left maxillary canine teeth. We had patient satisfaction and adequate keratinized tissue just with vestibuloplasty. CASE PRESENTATION Seventy years old female patient was referred to Izmir Katip Celebi University Dentistry Faculty with suffering from restricted lip movement and mastication. As a result of patient’s dental history, we learned that, she has been exposed to chemical (The adhesion was due to exposure to chemical agent as vitriol) agent in her mouth so there was a scar formation along the anterior mucogingival line, especially left maxillar anterior. There was decreased vestibular depth and inadequate keratinized tissue. There was no keratinized tissue and attached gingiva. Probing depth was 2 mm. There was 4 mm recession due to mucogingival stress caused by scar formation and decreased vestibular depth but, there was any pathologic pocket formation (Figure 1). After administration of local anesthesia, a straight-line incision was made from right first premolar teeth to left lateral teeth. A partial thickness dissection was done extending 6mm beyond the marginal gingiva of left canine. The incision was from distal of right central incisor to the distal of left first premolar. It was a split-thickness flap periosteum was left on the bone. There was no keratinized tissue in the coronal border of the flap. Figure 1 Clinical appearance before lip adhesion with vestibuloplasty treatment.
